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Generally, Medicare Part A (also known as hospital insurance) can cover inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare. 1
Medicare Part B (also known as medical insurance) offers coverage for medically necessary and preventive care services. Medically necessary services diagnose and treat health problems. It can include Durable Medical Equipment (DME) , mental healthcare or ambulance services. 2 Preventive care services are health treatments that prevent illness or detect problems at an early stage, like flu shots or cancer screenings. 3
Humana Medicare plans offer benefits beyond what Original Medicare covers. Explore all of the plans available in your area today!
There are some things Original Medicare won&#;t cover. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: 4
Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans are provided by private companies with approval from Medicare. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D). 5
An important note: If you want coverage for prescription drugs, you must sign up as soon as you&#;re eligible, unless you have what&#;s called &#;creditable&#; prescription drug coverage elsewhere. For example, if you&#;re still working and covered by your employer or your spouse&#;s employer sponsored health coverage, you may be able to wait.
Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. Many offer affordable or even $0 monthly plan premiums , but you must continue to pay the Medicare Part B premium.
Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. Prescription drug plans &#;called Medicare Part D&#;are only available through private companies like Humana. Premiums and the list of covered drugs&#;called a formulary&#;will vary by plan. 6
Original Medicare generally doesn&#;t cover the cost of a nursing home, assisted living or long-term care facility. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations.
If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. You may need to exhaust your personal resources on medical care before you are eligible.
Medicare Part B may cover diagnostic hearing and balance exams&#;tests your doctor requires if you need medical treatment. However, Medicare doesn&#;t cover routine hearing exams, hearing aids or fittings.7
Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids.
Medicare covers hospice care if the following conditions are met:
Medicare does help cover some in-home health services, including:
To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. Also, your doctor will need to certify that you need certain eligible in-home services.
Medicare will not pay for 24-hour in-home care or meals delivered to you at home. It also doesn&#;t cover help for what&#;s called &#;activities of daily living,&#; like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9
Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Your copays and deductibles will still apply.
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There is a long list of items covered, including:
Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. Medicare will only provide coverage through suppliers who participate in the Medicare program.10
Services that are not considered medically necessary are generally not covered by Medicare Part A or Part B. For example, breast augmentation for cosmetic reasons isn&#;t covered by Medicare, but reconstructive surgery after a mastectomy is covered.11
Medicare won&#;t cover Lasik surgery just to avoid the need for glasses. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.
Always err on the side of caution! Confirm your coverage before you commit to a procedure you&#;re unsure about.
Original Medicare generally covers most pre-existing conditions. For some conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you could be eligible for Medicare before you turn 65.
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and as long as you&#;re &#;homebound,&#; which means:
You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
Leaving your home isn&#;t recommended because of your condition.
You&#;re normally unable to leave your home because it&#;s a major effort.
Covered home health services include:
Medically necessary
part-time or intermittent skilled nursing care
only if you&#;re also getting skilled nursing care at the same time)
Durable medical equipment
Medical supplies for use at home
A doctor or other health care provider (like a nurse practitioner) must have a face-to-face visit with you before certifying that you need home health services. A doctor or other health care provider must order your care, and a Medicare-certified home health agency must provide it.
In most cases, "part-time or intermittent" means you may be able to get skilled nursing care and home health aide services up to 8 hours a day, with a maximum of 28 hours per week. You may be able to get more frequent care for a short time if your doctor or other health care provider determines it's necessary.
Medicare doesn't pay for:
that aren&#;t related to your care plan
that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need
You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care . You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.
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